DİRENÇLİ BAKTERİ KOLONİZASYONU TARAMASI YAPILMASININ CERRAHİ ALAN ENFEKSİYONU AÇISINDAN ÖNEMİ

Abstract

Cerrahi alan enfeksiyonları sağlık hizmeti ilişkili enfeksiyonların yaklaşık %20’sini oluşturmakta ve hastalarda artmış morbidite ile mortaliteye neden olmaktadır. Tarama amaçlı yapılan rektal sürüntü kültürlerinde ise hastaların dirençli bakteriler ile kolonize olduğunun anlaşılması yatış sürecindeki enfeksiyon riskini anlamlı olarak arttırmaktadır. Çalışmamızda hastanemiz Genel Cerrahi bölümü tarafından son beş yılda ameliyat edilen 3228 hastada gelişen 102 cerrahi alan enfeksiyonu (%3.16) verisini değerlendirdik. Çalışma süresince 86 hastada 168 etken ürediği ve sekiz hastada (%9.3) etkenin dirençli mikroorganizmalar olduğu görüldü. 16 hastada (%15.7) ise kültür için hiç örnek alınmadığı saptandı. Cerrahi alan enfeksiyonu gelişen hastaların 4 tanesinde dirençli bakteri tarama kültürü yapıldığı ve bu hastalardan birinde karbapenemaz üreten Gram negatif bakteri pozitifliği saptandığı anlaşıldı. Bu hastanın total gastrektomi sonrası gelişen karın içi apse kültüründe de yine karbapenemaz üreten Gram negatif bakteri, Escherichia coli üremesi oldu. Bu sonuçlar ile hastanemizde cerrahi alan enfeksiyonlarının önlenmesi için, tarama kültürü gibi önemli bir fırsatın yeteri kadar iyi kullanılamadığı sonucuna vardık. Etkin bir tarama ile daha fazla kolonize hastaya ulaşmamız mümkün olsa bu hastalarda izolasyon, yakından izlem ve cerrahi alan enfeksiyonu gelişmesi durumunda ise daha etkin bir tedavi planlama şansımız olacaktı. Sonuçta çalışmamız Genel Cerrahi tarafından ameliyat edilen hastalarda gerçekleştirilmesi gereken dirençli bakteri kolonizasyonu taraması konusunda önemli eksikliklerimiz olduğunu göstermiş ve cerrahi alan enfeksiyonu etkenlerinin saptanması konusunda da gelişim alanlarımız olduğunu belirlemiştir.

Keywords

• Cerrahi alan enfeksiyonu
• Çoklu dirençli bakteriler
• Dirençli bakteri kolonizasyonu taraması
• Karbapenemaz üreten Gram negatif bakteri

Impact of Multidrug-resistant Bacteria Colonisation Screening on Surgical Site Infections

Abstract

Surgical site infections constitute approximately 20% of healthcare-associated infections and increase morbidity and mortality rates. In the rectal swab cultures for multidrug-resistant bacteria colonization screening, colonized patients with resistant bacteria have a significantly increased risk of infection during their hospitalization period. Our study evaluated 102 surgical site infections (3.16%) developed in 3228 patients operated by the General Surgery team in the last five years. During the study period, 168 microorganisms were reported in 86 patients, and the causative microorganism in eight patients (9.3%) were multi-drug resistant. It was shown that no samples were taken for culture in 16 patients (15.7%). Multidrug-resistant bacteria colonization screening cultures were performed in 4 patients with surgical site infections, and carbapenemase producing Gram negative bacteria was found in one of them. That patient, who underwent total gastrectomy, had a postoperative intra-abdominal abscess, and a carbapenemase producing Gram negative bacteria, Escherichia coli, was reported in his abscess culture. With these results, we concluded that a significant opportunity, such as a screening culture, could not be used well enough to prevent surgical site infections in our hospital. If we reach more colonized patients with adequate screening, we would have the chance to plan timely isolation, close monitoring and more effective treatment in case of surgical site infection. As a result, our study showed that we have essential deficiencies in screening resistant bacteria colonization that should be performed in patients operated by General Surgery and determined that we have room for improvement in diagnosing surgical site infection causative microorganisms.

Keywords

• Carbapenemase producing Gram negative bacteria
• Multidrug-resistant bacteria
• Multidrug-resistant bacteria colonization screening
• Surgical site infections

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